Personal Views

A meeting too far

BMJ 1995; 310 doi: (Published 15 April 1995) Cite this as: BMJ 1995;310:1014
  1. Eva Lester

    Everyone agrees that doctors should be involved in management in the reformed health service but it depends what you mean by management. Since the 1991 reorganisation there has been an enormous increase in the number of non-medical managers. They spend much of their time in meetings. So do many doctors, but unfortunately our numbers have not similarly increased and the patients are still there.

    Before the reforms we had a medical staff committee composed of the consultant medical staff in the district. We met once a month at 5 o'clock and talked for two hours, mostly about how little notice the administration, as it was then, took of our views on any matter concerning the running of the hospital. Not that we often had a united coherent view.

    Now that we are a trust hospital the medical staff committee survives almost unchanged except that fewer consultants attend regularly. They come when they feel particularly threatened. We got a good turn out when our previous chief executive tried to make his name as the one who had made most consultants redundant in the shortest time since the introduction of the reforms. It is sad that the only occasion in 20 years when we managed to take concerted and effective action was when our own heads were on the block.

    We also have a clinical directors' board, which meets every week for two and a half hours starting at 11 30 in the morning. Those directors who happen to have a ward round, clinic, or operating session leave them early, handing responsibility over to their junior staff. The meeting is chaired by the chief executive, who was originally the only general management representative. Recently the finance director, the marketing director, the director of administration and operations, and the human resources director have joined the board. They seem to have taken over to such an extent that the medical members felt that the management was not receiving a clear message from the doctors. The medical executive director, therefore, set up a new medical policy group to discuss medical strategies relating to the trust. It has no non-medical members so I do not know how its views will be transmitted to the managers.

    Until a year ago, when I decided I had had enough, I was a member of our post-graduate medical education board, library committee, and trust audit committee. For six months I was also the consultant representative on the resource management team but resigned because I could not agree with the team's philosophy. It has just completed its three year contract at a cost to the regional health authority of about pounds sterling1m. Although there were a lot of meetings no resource management information system was commissioned and the group has now disbanded.

    I remain a member of the local negotiating committee and its representative to the joint staff consultative committee, which meets every two months. Before the reforms these meetings took place at lunch time. Now they take all afternoon and are much more ragged, perhaps because both managers and union representatives keep changing. Some managers move on to better things. Others and some union representatives have been made redundant. Although we were a first wave trust we still have not succeeded in establishing recognition arrangements for collective bargaining.

    Things are changing in the health service, but in spite of all the meetings the changes are confused and chaotic. Minutes of meetings, development of protocols, manufacturing of statistics do not alter reality. General managers sympathise with the aims of the reforms. Those who have doubts do not survive. If doctors want to influence the changes they need to agree on their objectives, which is not something they find easy. They must not be lured by the flattery of directorships into playing management games rather than managing. Real management is about things happening, the smooth running of procedures that are working well, the rational development of necessary changes. Above all, doctors must be sure that their involvement in management is not compliance with a political decision to destroy the NHS.—EVA LESTER is a consultant chemical pathologist in London

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